Tranexamic acid in pertrochanteric fractures: a retrospective analysis of perioperative outcomes after fixation with a proximal femoral nail
Abstract Background Treatment of pertrochanteric femoral fractures is often associated with significant blood loss. It has already been demonstrated that the administration of tranexamic acid (TXA) for endoprosthetic procedures reduces blood losses and leads to a decreased frequency of postoperative...
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| Format: | Article |
| Language: | English |
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BMC
2022-11-01
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| Series: | BMC Musculoskeletal Disorders |
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| Online Access: | https://doi.org/10.1186/s12891-022-05889-3 |
| _version_ | 1798044383497420800 |
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| author | John Hanke Thomas Mendel Matthias Wingert Philipp Schenk Markus Heinecke Arne Wilharm |
| author_facet | John Hanke Thomas Mendel Matthias Wingert Philipp Schenk Markus Heinecke Arne Wilharm |
| author_sort | John Hanke |
| collection | DOAJ |
| description | Abstract Background Treatment of pertrochanteric femoral fractures is often associated with significant blood loss. It has already been demonstrated that the administration of tranexamic acid (TXA) for endoprosthetic procedures reduces blood losses and leads to a decreased frequency of postoperative complications. The aim of this study is to demonstrate whether the administration of TXA as part of osteosynthesis treatment for pertrochanteric fractures using a proximal femoral nail reduces perioperative blood losses and haemorrhage-related complications. Methods In a two-centre retrospective cohort study, 1 g TXA i.v. was administered preoperatively to 294 patients who had suffered from pertrochanteric femoral fractures. The subjects were compared clinically to a historical control group who did not receive TXA (nonTXA). Outcomes were evaluated on the basis of perioperative blood loss, transfusion requirement, and occurrence of complications. Results The TXA group showed evidence of a reduction in blood loss (TXA = 0.97 ± 0.47 l; nonTXA = 1.06 ± 0.47 l; p = 0.004) and a lower frequency of transfusion (TXA = 20%; nonTXA = 31%; p = 0.032) as compared to the nonTXA group. However, evidence of this therapeutic effect could only be demonstrated at one of the centres on subgroup comparison between the two centres. At the second centre, the data did not show a significant difference. A trend could be seen towards a reduction in postoperative renal failure. No complications occurred resulting from the administration of tranexamic acid. Conclusion Preoperative administration of TXA does not lead to an increased rate of thromboembolic complications when applied for treatment of pertrochanteric femoral fractures. Evidence of a positive effect could be seen in principle in relation to the reduction in perioperative blood loss and the frequency of transfusion. The difference in effect between the two centres remains to be clarified: for this reason, it is possible to assume that further factors influencing the efficacy of TXA administration are at play which were not taken into account in this study. |
| first_indexed | 2024-04-11T23:02:53Z |
| format | Article |
| id | doaj.art-ab0d178dd242457db529c9d550a1ea62 |
| institution | Directory Open Access Journal |
| issn | 1471-2474 |
| language | English |
| last_indexed | 2024-04-11T23:02:53Z |
| publishDate | 2022-11-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Musculoskeletal Disorders |
| spelling | doaj.art-ab0d178dd242457db529c9d550a1ea622022-12-22T03:58:06ZengBMCBMC Musculoskeletal Disorders1471-24742022-11-0123111310.1186/s12891-022-05889-3Tranexamic acid in pertrochanteric fractures: a retrospective analysis of perioperative outcomes after fixation with a proximal femoral nailJohn Hanke0Thomas Mendel1Matthias Wingert2Philipp Schenk3Markus Heinecke4Arne Wilharm5Department of Trauma and Reconstructive Surgery, BG Klinikum Bergmannstrost Halle gGmbHDepartment of Trauma and Reconstructive Surgery, BG Klinikum Bergmannstrost Halle gGmbHDepartment of Trauma-, Hand- and Reconstructive Surgery, University Hospital JenaResearch Executive Department, BG Klinikum Bergmannstrost Halle gGmbHDepartment of Trauma and Reconstructive Surgery, BG Klinikum Bergmannstrost Halle gGmbHDepartment of Trauma-, Hand- and Reconstructive Surgery, University Hospital JenaAbstract Background Treatment of pertrochanteric femoral fractures is often associated with significant blood loss. It has already been demonstrated that the administration of tranexamic acid (TXA) for endoprosthetic procedures reduces blood losses and leads to a decreased frequency of postoperative complications. The aim of this study is to demonstrate whether the administration of TXA as part of osteosynthesis treatment for pertrochanteric fractures using a proximal femoral nail reduces perioperative blood losses and haemorrhage-related complications. Methods In a two-centre retrospective cohort study, 1 g TXA i.v. was administered preoperatively to 294 patients who had suffered from pertrochanteric femoral fractures. The subjects were compared clinically to a historical control group who did not receive TXA (nonTXA). Outcomes were evaluated on the basis of perioperative blood loss, transfusion requirement, and occurrence of complications. Results The TXA group showed evidence of a reduction in blood loss (TXA = 0.97 ± 0.47 l; nonTXA = 1.06 ± 0.47 l; p = 0.004) and a lower frequency of transfusion (TXA = 20%; nonTXA = 31%; p = 0.032) as compared to the nonTXA group. However, evidence of this therapeutic effect could only be demonstrated at one of the centres on subgroup comparison between the two centres. At the second centre, the data did not show a significant difference. A trend could be seen towards a reduction in postoperative renal failure. No complications occurred resulting from the administration of tranexamic acid. Conclusion Preoperative administration of TXA does not lead to an increased rate of thromboembolic complications when applied for treatment of pertrochanteric femoral fractures. Evidence of a positive effect could be seen in principle in relation to the reduction in perioperative blood loss and the frequency of transfusion. The difference in effect between the two centres remains to be clarified: for this reason, it is possible to assume that further factors influencing the efficacy of TXA administration are at play which were not taken into account in this study.https://doi.org/10.1186/s12891-022-05889-3Tranexamic acidProximal femoral fractureHaemoglobin monitoringGeriatricProximal femur nail |
| spellingShingle | John Hanke Thomas Mendel Matthias Wingert Philipp Schenk Markus Heinecke Arne Wilharm Tranexamic acid in pertrochanteric fractures: a retrospective analysis of perioperative outcomes after fixation with a proximal femoral nail BMC Musculoskeletal Disorders Tranexamic acid Proximal femoral fracture Haemoglobin monitoring Geriatric Proximal femur nail |
| title | Tranexamic acid in pertrochanteric fractures: a retrospective analysis of perioperative outcomes after fixation with a proximal femoral nail |
| title_full | Tranexamic acid in pertrochanteric fractures: a retrospective analysis of perioperative outcomes after fixation with a proximal femoral nail |
| title_fullStr | Tranexamic acid in pertrochanteric fractures: a retrospective analysis of perioperative outcomes after fixation with a proximal femoral nail |
| title_full_unstemmed | Tranexamic acid in pertrochanteric fractures: a retrospective analysis of perioperative outcomes after fixation with a proximal femoral nail |
| title_short | Tranexamic acid in pertrochanteric fractures: a retrospective analysis of perioperative outcomes after fixation with a proximal femoral nail |
| title_sort | tranexamic acid in pertrochanteric fractures a retrospective analysis of perioperative outcomes after fixation with a proximal femoral nail |
| topic | Tranexamic acid Proximal femoral fracture Haemoglobin monitoring Geriatric Proximal femur nail |
| url | https://doi.org/10.1186/s12891-022-05889-3 |
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